Form 5500 · Employee benefit plan · PORTLAND, OR
PENDLETON WOOLEN MILLS, INC.
The filing calls this plan PENDLETON WOOLEN MILLS HEALTH & WELFARE PLAN.
PENDLETON WOOLEN MILLS, INC. of PORTLAND, OR is a 696-participant manufacturing employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is WOODRUFF-SAWYER & CO. Coverage is written through REGENCE BLUECROSS BLUESHIELD OF OREGON and 6 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-0250770 · plan 508 · plan year 2025, filed Jul 13, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 7 insured contracts covering health, dental and vision; the largest, with REGENCE BLUECROSS BLUESHIELD OF OREGON, covers 342 people.
Reported premium is $4,480,387; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
WOODRUFF-SAWYER & CO is the broker of record on 1 of the 7 contracts; the rest name a different broker or none.
7 carriers appear on the filing, including REGENCE BLUECROSS BLUESHIELD OF OREGON, KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST, OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON and WILLAMETTE DENTAL INSURANCE, INC.. REGENCE BLUECROSS BLUESHIELD OF OREGON writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| REGENCE BLUECROSS BLUESHIELD OF OREGON | Health | 342 | Jan 1, 2026 | $3,343,917 | $0 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | Health, Dental | 115 | Jan 1, 2026 | $766,114 | $0 |
| OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | Dental | 417 | Jan 1, 2026 | $269,263 | $0 |
| WILLAMETTE DENTAL INSURANCE, INC. | Dental | 76 | Jan 1, 2026 | $41,215 | $0 |
| VISION SERVICE PLAN | Vision | 332 | Jan 1, 2026 | $40,463 | $0 |
| CANOPY | — | 579 | Jan 1, 2026 | $15,716 | $0 |
| NATIONAL UNION FIRE INS. CO. OF PITTSBURGH, PA | — | 310 | Jan 1, 2026 | $3,699 | $0 |
Premium and claims on this contract
WILLAMETTE DENTAL INSURANCE, INC., contract OR120. For the contract year on this filing, the carrier reported $41,215 in premium earned and $33,399 in claims incurred. Dividing one by the other gives 81%.
- WILLAMETTE DENTAL INSURANCE, INC., contract OR120 reported $5,152 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Reported to OSHA
Reported to OSHA for 2025: 14 employees, 3 recordable cases, 83 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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